Jacob M. Rose, individually and as of the Estate of Jack F. Rose and Jeremy P. Rose, individually v. Oakland Healthcare Management, LLC, d/b/a Oakland Manor

In the Iowa Supreme Court

No. 23–1788

Submitted November 13, 2025—Filed January 23, 2026

Jacob M. Rose, individually and as executor of the Estate of Jack F. Rose,

and Jeremy P. Rose, individually,

Appellants,

vs.

Oakland Healthcare Management, LLC, d/b/a Oakland Manor,

Appellee.

On review from the Iowa Court of Appeals.

Appeal from the Iowa District Court for Pottawattamie County,

Amy Zacharias, judge.

The plaintiffs seek further review of a decision of the court of appeals

affirming the dismissal of wrongful-death claims against defendant nursing

facility. Decision of Court of Appeals Affirmed in Part and Vacated in Part;

District Court Judgment Affirmed.

McDonald, J., delivered the opinion of the court, in which all justices

joined.

Peter Johnson (argued) and Jon H. Johnson of Johnson Law, P.L.C.,

Sidney, for appellants.

Jeff W. Wright (argued) and Zack A. Martin of Heidman Law Firm, P.L.L.C.,

Sioux City, for appellee.

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McDonald, Justice.

Cognizant of the potential liability arising out of the COVID-19 pandemic,

the general assembly passed the “COVID-19 Response and Back-to-Business

Limited Liability Act.” 2020 Iowa Acts ch. 1070, §§ 3–10 (codified at Iowa Code

chapter 686D (2021)). Among other things, the Act provides that, with respect to

COVID-19-related injuries or death, “[a] health care provider shall not be liable

for civil damages for causing or contributing, directly or indirectly, to the death

or injury of an individual as a result of the health care provider’s acts or

omissions while providing or arranging health care.” Iowa Code § 686D.6(1)

(2022). The Act contains an exception: it does not relieve a health care provider

for liability “for any act or omission which constitutes recklessness or willful

misconduct.” Id. § 686D.6(2). The plaintiffs in this case sued a health care

provider for wrongful death, alleging the health care provider’s reckless and

willful failure to comply with certain federally recommended practices related to

COVID-19 prevention resulted in the death of a resident in the provider’s facility.

The district court dismissed the suit on the defendant’s motion for summary

judgment, holding the plaintiffs failed to establish reckless or willful misconduct

as a matter of law. The plaintiffs challenge that decision in this appeal.

I.

Jack Rose became a resident at Oakland Manor, a Medicaid-participating

skilled nursing facility, in February 2019. Approximately one year later, in

March 2020, federal and state authorities declared a public health emergency in

response to the COVID-19 pandemic. In June of 2020, Rose was removed from

the facility and hospitalized for a medical condition (the record is not clear as to

the condition). On June 24, Rose was released from the hospital and returned to

Oakland Manor. Oakland Manor placed Rose in precautionary isolation for

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fourteen days in accordance with public health guidance to prevent the spread

of COVID-19. Rose tested negative for COVID-19 on July 7 and 10. On July 10

and 13, Rose had two off-site medical appointments. The off-site medical

appointments caused the facility to place Rose in precautionary isolation for

another fourteen-day period. The second period of precautionary isolation was

cut short when Rose was hospitalized for a suspected stroke on July 23. He

tested positive for COVID-19 on the day he was admitted to the hospital. Rose

died at the hospital on August 1. The death certificate listed Rose’s immediate

cause of death as COVID-19 infection due to acute hypoxic respiratory failure

and bacterial pneumonia. The death certificate listed other significant medical

conditions, including bacteremia, lactic acidosis, obesity, and diabetes.

In August and September of 2020, the Iowa Department of Inspection and

Appeals conducted a COVID-19 Focused Infection Control Survey at Oakland

Manor and an investigation of certain complaints related to Oakland Manor’s

response to COVID-19. Based on that survey and investigation, the Centers for

Medicare and Medicaid Services (CMS) issued a Statement of Deficiencies to

Oakland Manor in September, which we refer to as the CMS Report. The CMS

Report identified certain inadequacies in Oakland Manor’s practices related to a

variety of things, such as recordkeeping, confidentiality of private information,

and COVID-19 prevention. With respect to the last item, the CMS Report

identified deficiencies such as improper sanitization of the sit-to-stand lift, the

failure to complete hand hygiene, the failure to wear complete personal protective

equipment (PPE), and the failure to completely seal an isolation area. The CMS

Report noted that thirty of the thirty-one residents at the facility had tested

positive for COVID-19 during the course of the pandemic. The CMS Report

“identified that the facility was not in compliance with CMS and Centers for

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Disease Control and Prevention (‘CDC’) recommended practices to prepare for

COVID-19.”

At some point later, the record is not clear exactly when, local news

reported about the CMS Report and the issues at Oakland Manor. Jack’s sons,

Jacob and Jeremy (the Roses), learned about the report and the shortcomings at

Oakland Manor from the news. They retained counsel and brought this suit

individually and on behalf of the estate of Jack Rose. They asserted claims for

(1) wrongful death, (2) breach of contract, (3) dependent adult abuse, (4) loss of

consortium, and (5) punitive damages.

Oakland Manor asserted the health care provider immunity as an

affirmative defense pursuant to Iowa Code section 686D.6. Later, Oakland

Manor moved for summary judgment, arguing (1) that the alleged deficiencies

identified in the CMS Report did not, as a matter of law, rise to the level of

reckless or willful misconduct required to overcome the statutory immunity and

(2) that the plaintiffs could not establish causation as a matter of law. The parties

agreed that the statutory immunity applied to all of the plaintiffs’ claims.

The plaintiffs resisted the summary judgment motion, but the evidence in

support of the resistance was sparse. They did not put into the record any

affidavits or deposition testimony from any employee or resident of the facility

during the time Rose was a resident there. They did not put into the record any

affidavits or deposition testimony from any of the persons who conducted the

survey or investigation. They did not put into the record any affidavits or

deposition testimony from any of the persons who prepared the CMS Report. The

Roses had no personal knowledge of what occurred in the facility because they

never visited Jack in the facility in the one and a half years he was a resident

there despite living nearby. The only evidence the plaintiffs put in the record in

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support of their resistance to the motion for summary judgment was the CMS

Report1 and their expert witness disclosure. The expert witness disclosure

identified a registered nurse, Jaylin Mincer, as the plaintiffs’ expert witness and

provided a summary of her expected testimony. Mincer’s expected opinion

testimony, as set forth in the disclosure, was based on reading the death

certificate and the CMS Report. Based on reading those two documents, it was

her opinion “that the death of Jack F. Rose [wa]s due to the negligent care and

wanton violation of Federal, State, and facility regulations regarding the

prevention of Covid-19.” She explained that “[t]he report also showed that the

Oakland Manor failed to follow property infection control guidelines to prevent

the spread of infection (Covid-19) such as failure to follow isolation guidelines,

improper and incomplete PPE use (masks, gloves, Disinfectant), which was the

cause of contracting Covid-19 and the death of Jack M. Rose.”

The district court granted Oakland Manor’s motion for summary judgment

and dismissed the case. The district court explained that the statutory immunity

provided that a health care provider could not be liable for civil damages while

providing or arranging care. See Iowa Code § 686D.6(1). It further explained that

the immunity included “[a]cts or omissions undertaken by a health care provider

relating to use or nonuse of personal protective equipment.” (Quoting id.

§ 686D.6(1)(c)(6).) The district court correctly held that the statute allowed

liability upon a showing of recklessness or willful misconduct, but it held that

the summary judgment record, even when viewed in the light most favorable to

the plaintiffs, did not establish reckless or willful misconduct. It showed the

1The parties dispute whether the CMS Report would have been admissible at trial, but

we need not resolve that dispute to resolve this appeal. For the purposes of this appeal, we

assume that it would have been.

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failure to comply with CMS regulations, which might amount to negligence per

se, at most.

A divided panel on the court of appeals affirmed the dismissal. The court

of appeals held that Oakland Manor exhibited “some failures” in its response to

COVID-19 but the evidence did not show conduct that rose to the level of

recklessness. The court of appeals also held that, even if the plaintiffs had

created a triable issue of fact with respect to recklessness, the Roses’ claims

failed as a matter of law due to the lack of any admissible evidence regarding

causation. The court of appeals reasoned that Mincer was not qualified to opine

on the transmission of infectious diseases, as would be required to establish the

chain of causation between Oakland Manor’s conduct and Jack’s death. A

dissenting judge would have allowed the Roses’ claims to proceed to trial. We

granted the Roses’ application for further review.

II.

We review summary judgment rulings for correction of errors at law.

Kostoglanis v. Yates, 956 N.W.2d 157, 158 (Iowa 2021). “Summary judgment is

proper when the movant establishes there is no genuine issue of material fact

and it is entitled to judgment as a matter of law.” Id. at 158–59 (quoting

Goodpaster v. Schwan’s Home Serv., Inc., 849 N.W.2d 1, 6 (Iowa 2014)). When a

motion for summary judgment is made and properly supported, the opposing

party may not rest upon the mere allegations or denials in the pleadings. Iowa

R. Civ. P. 1.981(5); see also Bitner v. Ottumwa Cmty. Sch. Dist., 549 N.W.2d 295,

299 (Iowa 1996). “Instead, the resisting party must set forth specific material

facts, supported by competent evidence, establishing the existence of a genuine

issue for trial.” Rottinghaus v. Lincoln Sav. Bank (In re Est. of Franken), 944

N.W.2d 853, 858 (Iowa 2020). “A fact is material if it will affect the outcome of

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the suit, given the applicable law.” Parish v. Jumpking, Inc., 719 N.W.2d 540, 543

(Iowa 2006). An issue of fact is “genuine” if the evidence would allow “a

reasonable jury [to] return a verdict for the nonmoving party.” Fees v. Mut. Fire

& Auto. Ins., 490 N.W.2d 55, 57 (Iowa 1992). It is well established that

“[s]peculation is not sufficient to generate a genuine issue of fact.” Nelson v.

Lindaman, 867 N.W.2d 1, 7 (Iowa 2015) (quoting Hlubek v. Pelecky, 701 N.W.2d

93, 96 (Iowa 2005)).

III.

As discussed above, the general assembly shielded health care providers

from civil liability for COVID-19-related injury or death “as a result of the health

care provider’s acts or omissions while providing or arranging health care.” Iowa

Code § 686D.6(1). This includes, among other things, the “screening, assessing,

diagnosing, caring for, or treating individuals with a suspected or confirmed case

of COVID-19” and for “[a]cts or omissions . . . relating to use or nonuse of

personal protective equipment.” Id. § 686D.6(1)(a), (c)(6). The statute creates a

limited exception and allows civil liability where a health care provider recklessly

or willfully caused injury or death. Id. § 686D.6(2). The parties in this case do

not dispute that Oakland Manor is a health care provider and that the statute

applies to the claims asserted here. They only contest whether the plaintiffs

resisted the defendants’ motion for summary judgment with sufficient evidence

to create a triable issue of fact on whether Oakland Manor acted recklessly.

We have never considered recklessness in the context of section 686D.6,

but the standard for recklessness is well-established in our caselaw. It “means

something more than ‘the mere unreasonable risk of harm in ordinary

negligence.’ ” Martinez v. State, 986 N.W.2d 121, 125 (Iowa 2023) (quoting Bell v.

Cmty. Ambulance Serv. Agency, 579 N.W.2d 330, 335 (Iowa 1998)); see also

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McCornack v. Pickerell, 294 N.W. 746, 747–48 (Iowa 1940) (“Recklessness is a

different term than negligence and includes more.”). To establish recklessness,

a plaintiff must prove the actor intentionally performed an act of an

unreasonable character, that the intentional act was in disregard of a known

risk or risk so obvious that the actor should have known of it, and that the

intentional act made it highly probable that harm would follow. Penny v. City of

Winterset, 999 N.W.2d 650, 653 (Iowa 2023); Martinez, 986 N.W.2d at 125. In

short, Iowa law imposes a high bar to establish recklessness; it is a difficult

standard to meet. Penny, 999 N.W.2d at 653.

An example of recklessness in relation to the pandemic is the case of State

ex rel. Clinton No. 1, Inc. v. Baker, 708 S.W.3d 474 (Mo. 2024) (en banc). In that

case, a woman contracted for a private room with a health care and rehabilitation

center. Id. at 476. Despite the woman’s contract for a private room, the center

placed a COVID-19-infected roommate in the woman’s room thereby exposing

the woman to COVID-19. Id. “As a result of the roommate placement, Gray

contracted and was diagnosed with COVID. Four days after the diagnosis, Gray

was sent to a hospital for evaluation and treatment. A week after the diagnosis,

she died.” Id. at 476–77. The woman’s daughter brought suit against the center.

Id. at 476. The center, asserting a similar statutory immunity as Oakland Manor

here, moved to dismiss the claim on the ground that the allegations in the

petition failed to establish recklessness. Id. at 480. The Supreme Court of

Missouri concluded that placing an infected person in the mother’s room despite

her contract for a private room was sufficient to show recklessness. Id. at 480–

81.

The summary judgment record in this case contains no similar evidence

that could support a finding that Oakland Manor acted recklessly or willfully.

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Unlike the Missouri case, where the defendant took deliberate action in violation

of the patient’s contract, the record here reflects only lapses in infection-control

protocols. The CMS Report identifies only that Oakland Manor failed to act in

certain circumstances and failed to fully comply with certain regulations relating

to the prevention of COVID-19 infection. The CMS Report states that Oakland

Manor staff would sometimes miss screening residents, not that they never

screened residents. The report states that Oakland Manor’s staff sanitization and

hand hygiene habits were inconsistent, not ignored altogether. Staff wore PPE in

the form of masks, gowns, and gloves, but staff did not consistently change their

gowns and gloves. Oakland Manor had an isolation area, but the isolation area

was not fully sealed. These deficiencies sound in negligence, perhaps even

negligence per se, but not recklessness. The deficiencies identified in the CMS

Report, whether considered together or in isolation, reflect the lack of adherence

to recommended protocols—failures of execution or consistency—rather than

intentional acts done with conscious disregard of a known or obvious risk. These

are the very type of shortcomings for which the legislature eliminated civil

liability as a matter of public policy.

Other courts addressing similar claims against health care providers

arising out of COVID-19-related death or injury have reached the same

conclusion. See, e.g., Kennestone Hosp., Inc. v. Turner, 914 S.E.2d 439, 443 (Ga.

Ct. App. 2025) (holding defendants were entitled to COVID-19 immunity from

plaintiff’s medical malpractice claim for failure to timely administer a medication

because while plaintiff “allege[d] conduct that may constitute inattentiveness or

negligence,” the only support for gross negligence were “conclusory allegations”);

Arbor Mgmt. Servs., LLC v. Hendrix, 875 S.E.2d 392, 400 (Ga. Ct. App. 2022)

(holding a nursing home’s poor decisions early in the pandemic “to allow

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visitation, socialization, and recreation at the residential facility” did not

overcome COVID-19 immunity because the facility’s response may have been

“belated and fell short, but it did respond”); Fluhr v. Anonymous Dr. 1, 234 N.E.3d

912, 919 (Ind. Ct. App. 2024) (holding there was no evidence of conduct sufficient

to overcome COVID-19 immunity and affirming summary judgment); Est. of

Campbell v. Woodcliff Health & Rehab. Ctr., 318 A.3d 708, 723 (N.J. Super. Ct.

App. Div. 2024) (“Plaintiff is simply without facts to demonstrate that defendants’

alleged breach of the standard of care . . . amounted to more than simple

negligence; certainly there is nothing in the facts alleged to demonstrate an

extreme or reckless deviation . . . .”); Est. of Pierro v Carmel Richmond Healthcare

& Rehab. Ctr., 241 N.Y.S.3d 299, 302 (App. Div. 2025) (holding that bare

allegations of failure to adequately prevent the spread of COVID-19 are

insufficient to establish recklessness); Barbaro v. Eger Health Care & Rehab. Ctr.,

No. 150689/2022, 2024 WL 3405761, at *4 (N.Y. Sup. Ct. July 11, 2024) (“While

failing to maintain an adequate infection control program could constitute

negligence, it does not rise to the level of morally culpable, reckless conduct

necessary to establish gross negligence.”); Hasan v. Terrace Acquisitions II, LLC,

194 N.Y.S.3d 445, 447 (Sup. Ct. 2023) (holding defendant’s failure “to maintain

an infection control program with policies designed to provide a safe, sanitary,

and comfortable environment in which residents vulnerable to infection

reside . . . may demonstrate negligence, [but does] not rise to the level of willful

conduct that evidences a high degree of moral culpability”); Crampton v. Garnet

Health, 155 N.Y.S.3d 699, 711 (Sup. Ct. 2021) (“[W]hile Plaintiffs do make

conclusory allegations of reckless misconduct . . . , their Complaint is grounded

in allegations of ordinary negligence.” (citations omitted)).

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Mincer’s expert opinion, even when considered in conjunction with the

CMS Report, also does not generate a genuine issue of fact regarding

recklessness. An expert opinion may give rise to a reasonable inference of

recklessness, but the expert opinion must be based on facts in the record or

opinion testimony demonstrating recklessness. See Penny, 999 N.W.2d at 655;

Feld v. Borkowski, 790 N.W.2d 72, 81 (Iowa 2010). Although Feld v. Borkowski

arose in a different context—a recreational sports injury—it provides our most

instructive guidance on the type of expert analysis that may be sufficient to

generate a genuine issue of fact regarding recklessness. 790 N.W.2d 72. In that

case, we considered whether a defendant’s actions in a contact sport reached the

threshold of recklessness. Id. at 80. There, the defendant, a right-handed hitter,

hit a baseball toward the third-base line but released his bat with such force and

in such an “abnormal, contorted” manner that it traveled sixty feet to strike the

first baseman. Id. The expert in that case, a seasoned coach, utilized a detailed

physics-based analysis to explain that such an event was functionally impossible

during a normal swing. Id. He concluded the bat must have been deliberately

released in “momentary frustration and anger,” thereby providing a factual basis

for a jury to infer the required mental state. Id. at 81.

In contrast to the expert opinion in Feld that provided extensive factual

detail and opinion showing recklessness, Mincer offered only a conclusory

opinion. Mincer conducted no independent factual investigation. She reviewed

only the CMS Report and the death certificate. Her resulting opinion lacked any

factual detail regarding Oakland Manor’s conduct, and it lacked any analysis

supporting an inference that Oakland Manor’s conduct was intentional rather

than merely negligent. This type of conclusory expert opinion is insufficient to

create a genuine issue of disputed fact supporting an inference of recklessness.

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See Penny, 999 N.W.2d at 655. Her labeling the alleged violations as “wanton”

without any supporting factual detail and analysis is mere ipse dixit and not

enough to create an issue of fact for the jury. See Bristow v. Nemours Found.,

No. N21C–03–240, 2023 WL 4994093, at *9 (Del. Super. Ct. 2023) (“Although

the Plaintiffs’ expert uses the term ‘reckless,’ nothing in her report suggests that

the precise harm . . . was reasonably apparent and consciously ignored by [the

defendant]. Errors of judgment or mere inadvertence do not constitute willful or

wanton misconduct.”).

IV.

Courts are required to examine the record “to determine whether there is

sufficient evidence from which a jury might reasonably draw an inference of

reckless[ness].” Vipond v. Jergensen, 148 N.W.2d 598, 600 (Iowa 1967). The

plaintiffs failed to support their resistance to the motion for summary judgment

with evidence sufficient to create a triable issue of fact for a jury. For these

reasons, we conclude the district court did not err in granting the defendant’s

motion for summary judgment. Because we conclude that the plaintiffs failed to

establish recklessness as a matter of law, we need not address the issue of

causation, and we vacate the court of appeals opinion regarding causation.

Decision of Court of Appeals Affirmed in Part and Vacated in Part;

District Court Judgment Affirmed.